中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (09): 632-635.doi: 10.3969/j.issn.1671-4091.2014.09.006

• 临床研究 • 上一篇    下一篇

短期应用碳酸镧对维持性血液透析高磷血症患者的血磷及血FGF23 的影响

马杰,于阳,李雪梅   

  1. 1. 中国医学科学院北京协和医院  北京协和医院  北京协和医院肾内科
  • 收稿日期:2014-06-24 修回日期:2014-07-29 出版日期:2014-09-12 发布日期:2014-09-02
  • 通讯作者: 于阳 yuyang@medmail.com.cn E-mail:yuyang@medmail.com.cn
  • 基金资助:

    国家科技支撑计划(2011BAI10B02，2012BAJ18B03)；首都卫生发展科研专项项目(首发2011-4001-08)

Effects of lanthanum carbonate on serum phosphate and serum FGF23 in maintenance hemodialysis patientswith hyperphosphatemia

  • Received:2014-06-24 Revised:2014-07-29 Online:2014-09-12 Published:2014-09-02

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摘要： 目的研究短期使用碳酸镧治疗对终末期肾脏病维持性血液透析(maintenance hemodialysis，MHD)高磷血症患者血清成纤维生长因子-23(fibroblast groth factor-23, FGF23)、Klotho 蛋白的影响。方法来自北京协和医院血液净化中心12 例并发高磷血症(透析前血磷＞1.78 mmol/L)的MHD 患者纳入本研究。经过2 周磷结合剂洗脱后，根据患者血磷水平予以相应口服剂量的碳酸镧片剂治疗，给药第2 周根据患者血清钙磷水平调整药物剂量，疗程为4 周，4 周后停用碳酸镧继续服用原剂量的碳酸钙1 月。总观察期为10 周。结果12 例患者完成全部观察。经碳酸镧治疗4 周后，10 例患者血磷明显下降，6 名患者血磷控制在1.78mmol/L 以内(2.33 ± 0.09 mmol/L 比1.51 ± 0.06 mmol/L，P =0.003)，4 周后停用碳酸镧，继续服用原剂量碳酸钙，1 月后复查血磷，9 名患者血磷均有所升高(1.76±0.10 mmol/L 比2.23±0.10mmol/L，P =0.040)。使用碳酸镧前后及更换碳酸钙1 月后12 名患者血钙、iPTH 无明显变化。12 名患者服用碳酸镧后FGF23 均有不同程度的下降，停用碳酸镧后使用碳酸钙治疗1月后FGF23 水平有明显升高(P<0.05)。血清α-Klotho 蛋白水平在使用碳酸镧治疗后所有患者α-Klotho 水平均有明显下降，停用碳酸镧服用碳酸钙1 月后α-Klotho 水平仍然持续偏低，升高不明显。结论碳酸镧可有效纠正MHD患者的高磷血症，短期即可降低这些患者血清FGF23水平。

关键词: 维持性血液透析, 高磷血症, 碳酸镧, FGF23, α-Klotho

Abstract: Objective To evaluate the short- term efficacy of lanthanum carbonate in treating maintenance hemodialysis (MHD) patients with hyperphosphatemia. Methods A single center, open- labeled study from Peking Union Medical College Hospital was performed. Phosphate binders were discontinued during a two-week washout period. Patients with more than 1.78 mmol/L serum phosphorus after two-week washout period were eligible for the study. The dose was adjusted after first two weeks as necessary to achieve lower serum phosphorus. Lanthanum carbonate was administered to 12 MHD patients for 4 weeks, followed by taking
the original dose of calcium carbonate for 4 weeks. Results All patients fulfilled the whole study. After 4 weeks of treatment with lanthanum carbonate, serum phosphorus decreased significantly in 10 patients, and serum phosphorus was controlled to less than 1.78 mmol/L in 6 patients (2.33±0.09 vs. 1.51±0.06 mmol/L, P= 0.003). After continued use of the original dose of calcium carbonate for 4 weeks, serum phosphorus increased in 9 patients (1.76±0.10 vs. 2.23± 0.10 mmol/L, P=0.040). However, the levels of serum calcium and serum intact parathyroid hormone kept steady after the 10 weeks’observation. The levels of serum FGF23 and α-Kloth decreased after taking lanthanum carbonate in all 12 patients (P<0.05), and the level of FGF23 slightly increased after taking calcium carbonate for 4 weeks. Conclusions Lanthanum carbonate can control serum phosphorus, reduce the levels of serum FGF23 in a short term.

Key words: Hemodialysis, Hyperphosphatemia, Lanthanum carbonate, FGF23, α- Klotho